Head Injury 101

Prevention, Treatment & Recovery.

“There’s Always Hope”

Skull Fracture.

Hopefully today's topic is written in a manner that is simple and concise, so your conversation with the medical personnel is much easier. 

The skull is the the bony skeleton that cover and protect the delicate brain. Along with the scalp they form the protective layer shielding the brain from the hostile external environment. The skull is the Armor of the brain.

There are two major anatomical region in term of skull fracture, base of skull fracture & skull vault fracture.   

A) Base of Skull fracture (BoS)

Complications that can arises from BoS fracture are 

> CSF leakage

This may present as clear fluid dripping through the nose, CSF rhinorrhoea. Many have come to notice  when they bend forward, such as when they wash their face or looking down to the floor while picking up objects.

or dripping through the ears, CSF otorrhoea. some may complain to have clear fluid at the ears after waking up from sleep.

or post nasal dripping, a sensation of fluid drip or flowing down the throat.

    

> Meningitis

The fracture site breach the  protective barrier and form a passage allowing the spread of organisms to the meninges and subsequently lead to meningitis.

> CSF Fistula formation

as a result of prolong CSF leak and non healing, a fistula is from connecting the two compartment between the brain and the mucosa. Often extensive radiological investigation and endoscopic examination are used to identify the site of fistula.   

> Nasal bleed

This usually occur immediate post trauma when the arteries are severed. The sphenopalatine artery or the ethmoidal artery could be involved and often required nasal packing and possibility of further intervention such as surgical ligation or embolization when uncontrolled. 

> Cranial nerves (CNs) injury

There are twelve pairs of CNs and they exit the skull via the BoS. The symptoms and injury arises depend on which CNs are injured, for example the facial nerve could be injured in a middle cranial fossa fracture. The hearing could be involve as the middle ear structure are house in the middle cranial fossa as well.

** Important Notes: 

Caution!!! 

Do not place in a NG tube in those with suspected base of skull fracture or CSF leak. 

B) Skull vault fracture:

This can  be sub categorized into close or open fracture.

A close fracture occur when the fracture does not expose the content to the external environment, i.e the protective scalp is intact and conversely when the covering scalp is breach and the skull is exposed it is an OPEN skull fracture. The risk of infection is much higher when there's open fracture.

It can also be categorized according to the morphology of the fracture

i. Linear fracture- the simple skull breakage that is not displace, i.e does not press down towards the brain.

ii. Compound Fracture.- The skull breakage into multiple pieces. 

iii. Depressed fracture - The broken skull piece is push down towards the underlying brain and this is depress skull fracture. often surgical intervention is needed as the 

Other complications of skull fracture 

1. Intracranial bleeding 
- Extradural hematoma, Subdural hematoma.

2. Underlying brain injury
 - Contusion, cerebral laceration, 

3. Pneumocephalus

4. Occipital atlanto fracture and instability.

abbreviation:

CN - cranial nerve

CSF- Cerebrospinal fluid

BoS- Base of Skull

The photo shown below may be difficult, kindly skip the photo is you are not ready to watch. Thanks.

Guess what type of fracture is this?
Leave your answer on the comment box.